摘要目的 探讨肝切除术和肝移植治疗符合米兰标准肝癌患者的疗效.方法 回顾性分析2002年7月至2009年2月南京军区福州总医院行肝切除术和肝移植治疗121例符合米兰标准且合并肝硬化、肝功能为Child A级的原发性肝癌患者的临床资料,其中89例行肝癌切除术的患者作为肝切除术组；32例行肝移植的患者作为肝移植组.两组患者在年龄、性别、肝硬化病因、肿瘤最大直径、肿瘤数目、微血管侵犯、微小卫星灶、肿瘤分化程度方面比较,差异无统计学意义.对两组患者资料进行回顾性比较分析,Kaplan-Meier法计算生存时间,Log-rank分析生存曲线之间的差别,COX比例风险模型单因素、多因素分析影响预后的因素.结果 中位随访时间37个月,肝切除术组患者1、3、5年生存率分别为86％、63％、44％,肝移植组患者1、3、5年生存率分别为87％、70％、62％,两组总体生存率比较,差异无统计学意义(x2=1.092,P＞0.05)；肝切除术组患者1、3、5年无瘤生存率分别为68％、44％、26％,肝移植组患者1、3、5年无瘤生存率分别为80％、65％、52％,两组总体无瘤生存率比较,差异有统计学意义(x2=4.712,P＜0.05).单因素分析结果显示:微血管侵犯、微小卫星灶与生存显著相关(Wald=9.625,7.340,P＜0.05)；多因素分析结果显示:微血管侵犯是影响生存的独立危险因素(Wald=5.008,P＜0.05).结论 对于符合米兰标准的肝癌患者行肝切除术和肝移植比较总体生存率无明显差异,但肝移植术后患者无瘤生存率高于肝切除术；微血管侵犯是影响患者生存的独立危险因素.

abstractsObjective To compare the efficacies of hepatectomy and liver transplantation for patients with hepatocellular carcinoma (HCC) fulfilling the Milan criteria.Methods From July 2002 to February 2009,121 patients with HCC combined with hepatic cirrhosis fulfilling the Milan criteria were admitted to the Fuzhou General Hospital.Eighty-nine patients who received hepatectomy were in the hepatectomy group,and 32 patients who received liver transplantation were in the liver transplantation group.There were no significant difference in the age,gender,etiology of liver disease,the size of the largest tumor,number of tumors,microscopic venous invasion,microsatellite lesion and tumor differentiation between the 2 groups.The clinical data of the patients in the 2 groups were retrospectively analyzed.The overall survival and disease-free survival were evaluated by Kaplan-Meier method,and differences in survival rates between the 2 groups were determined by Log-rank test.COX proportional hazard was used for univariate and multivariate analysis to evaluate the risk factors for prognosis.Results The median period of follow-up was 37 months.The 1-,3-,5-year survival rates were 86％,63％ and 44％ in the hepatectomy group,and 87％,70％ and 62％ in the liver transplantation group.There was no significant difference in the overall survival rate between the 2 groups (x2 =1.092,P ＞ 0.05).The 1-,3-,5-year disease-free survival rates were 68％,44％ and 26％ in the hepatectomy group,and 80％,65％ and 52％ in the liver transplantation group.There was a significant difference in the disease-free survival rate between the 2 groups (x2 =4.712,P ＜ 0.05).The result of univariate analysis revealed that microscopic venous invasion and microsatellite lesion were significantly correlated with the survival (Wald =9.625,7.340,P ＜ 0.05),and the result of multivariate analysis indicated that microscopic venous invasion was the independent risk factor influencing the survival (Wald =5.008,P ＜ 0.05).Conclusions As for patients with HCC fulfilling the Milan criteria,the overall survival rate of patients who received hepatectomy is not different from those who received liver transplantation,but the disease-free survival rate of patients who received liver transplantation is higher than those who received hepatectomy.Microscopic venous invasion is an independent risk factor influencing the survival.